Modern humans tend to live very lopsided lives when it comes to sports, daily habits, how we sit for work and how we hold babies, purses, backpacks etc.
Many people are walking around with a pelvic or hip instability issue without even knowing it. This is because the human body is amazing at compensating. It will compensate and compensate, sometimes for years without any pain at all…until one day it can’t take any more, and that’s when we get a pain signal.
The list of possible injuries or pain patterns that can happen due to a hip instability pattern are so numerous we’d be here all day if I went into them all, but the big surprise is plantar fasciitis.
If you’ve tried all the typical routes or methods of eliminating plantar fasciitis and your pain persists, it could be due to an underlying hip or pelvic instability issue. (Click here to learn about the most common causes of plantar fasciitis).
The short story on this complex issue:
Due to one or more imbalances in the fascia of the legs, your pelvis can experience a tilt, shift or rotation (or some combination thereof). This means it could be rotated forward on one or both sides, tilted to the left or right or otherwise shifted out of alignment.
When this happens, it is my belief that your brain detects potential danger to the central nervous system and spine (which requires a neutral pelvis to be at optimal health), and recruits one or more muscles of the low back or hip to contract neurologically to bring you back into balance.
Often, it’s the gluteus medius that is recruited this way and when it is – that muscle is no longer able to be recruited for its normal duties.
What does the gluteus medius do?
Gluteus medius and minimus abduct the thigh when the leg is straight and during gait (walking or running) these two muscles function to support the body on one leg to prevent the pelvis from dropping to the opposite side.
With the hip flexed, gluteus medius and minimus internally rotate the thigh. With the hip extended, they externally rotate the thigh, or more accurately they act to prevent internal rotation. Without this action the knee migrates inward, creating stress on the structures of the hip, knee and foot.
As you can tell, gluteus medius (and minimus) are critical for hip stability in ALL kinds of everyday actions. If one or both of these muscles is no longer able to do its job, it has to be done by other muscles.
How glute inhibition or hip instability leads to plantar fasciitis:
If you’ve had plantar fasciitis (or any pain) for a while, chances are you’ve tried one or more of the traditional treatment methods. Have you wondered why they’re not ‘working’? While this post is plantar fasciitis specific, the opinions expressed here would be the same for just about any pain in the body.
Don’t address symptoms, address the ROOT CAUSE!
While this isn’t a complete list, I wanted to address some of the most commonly used traditional methods for relieving plantar fasciitis and why they typically don’t work long term. Please keep in mind this is my opinion, and I am in no way suggesting you disregard the advice of a medical professional.
While rest can be helpful, I do not believe it solves the problem at its root. Movement reveals and heals! So while I will always condone appropriate rest, I remain a fan of movement and staying mobile. Movement allows your body to tell you something is wrong (or not), and movement can often help heal.
Using cold, either icing your foot or rolling it on a frozen water bottle, will provide temporary reprieve from the pain because ice dulls our pain receptors. The pain is still there, we just can’t feel it as strongly. As soon as the effects of the ice wear off the pain will likely come back. It’s also not addressing the root cause.
Brace or compression sleeve:
Wearing a brace or compression sleeve is a tempting plan for many looking for an ‘alternative’ approach. Most of the time we’ll wear a brace while working out, but some people like how it feels so much they wear it all day AND while sleeping. (Or, have you been told to wear the kind that places your foot in dorsiflexion all night?! I am very much against that…more on that in a minute).
Wearing a brace or compression sleeve may feel good temporarily, but the reasons it feels good are the same reasons this can kick the pain can down the road and/or make things worse (when you take it off). A brace, especially a tight one, partially immobilizes whatever joint you’re wearing it around; so you can’t move like you normally would. It may also cut off blood flow and block some nerve communication. It’s also forcing your fascia into a tight mold, and if you wear it long enough – that mold will become your new normal, the fascia stops being elastic and flexible, it loses its spring due to lack of proper blood flow and generally puts you into a scenario that will make eliminating your pain at the source even more difficult.
A night brace or sleeve that attempts to force you into dorsiflexion all night is a personally horrifying choice to me, because it’s like trying to hold a static stretch for 7-8 hours! I’m against static stretching to begin with, and trying to force your tissue (while cold and immobilized) to hold a stretch that long is just asking for something worse to happen. Muscle tissue has a tendency to resist static stretching, and more than likely it’s not your muscle tissue that’s the problem anyway…so even if you accomplish the job of lengthening those muscle fibers, chances are slim it will relieve or eliminate your pain; and it just might make things a lot worse, since the chances of irritating your attachments are now very high.
I won’t be going into detail on the various kinds of painkillers. Bottom line is: pain pills work by blocking pain receptors in your brain. The pain is still there, we just don’t feel it anymore. So it may give us temporary relief, but pills will never address the root issue.
This option may sound like a good choice at first. Maybe you buy new shoes and suddenly your pain seems better! Until you take the shoes off.
If you baby your pain and try to silence it during the day while wearing specific shoes, while NOT addressing the root cause – then you’ve set yourself up to rely on soft shoes in order to feel less or no pain, but again, this isn’t addressing the root cause and the more you baby the pain the more likely it is to get worse in the long run.
Besides: don’t you want the option to go barefoot or wear flip flops or whatever shoes you want to wear?
Orthotics (shoe inserts):
Similar to the cushiony shoes, orthotics are not addressing the root cause and it’s another bandaid solution that makes you reliant on wearing it to feel less or no pain.
If your plantar fascia is really tight, or you have “flat feet” – those things are symptoms of mobility issues or a result of how you move through life or sports. They’re reversible too!
Not only will orthotics create another scenario of babying the pain (and when you take them out or try to go barefoot the pain usually comes raging back), but – it’s entirely possible you’ll experience new pain you never had before. Orthotics change your gait pattern, and any time you change your gait pattern you monkey with your joint and alignment. I’ve had lots of clients get orthotics for a foot issue, only to end up with knee or hip pain, or their spine going out of alignment.
Again – it’s not addressing the root cause of plantar fasciitis (or any pain).
This is possibly a controversial stance to take, but it’s been my position for years: these shots are meant to be “merely” anti-inflammatory in nature, but there are a whole bunch of possible side effects that simply aren’t worth it (in my opinion). I am not telling you not to go for it if you want to, though I would hope you’d do so after investigating for yourself and knowing the risks (especially for shots in the feet!)
Click here to read the full list of potential side effects on the Mayo Clinic website.
Even IF these shots came with zero risk and simply took the inflammation down, it would still be my position that this isn’t addressing the root cause and by decreasing inflammation without addressing the root cause, we could make things worse in the long run.
Consider these possible side effects:
Thinning of skin
Necrosis of nearby tissue
Necrosis of nearby bone
Tendon and ligament rupture
AND – the risk of experiencing any of these side effects goes up with every injection
The reason I am horrified by the thought of cortisone injections in the feet specifically is because we have so many small bones, tendons, ligaments, TONS of nerves, lots of fascia, many small joints etc. The chances of damaging any or all of these areas is significantly higher than say, getting a shot in your knee or shoulder – IN MY OPINION.
And remember – a shot does nothing to address the root cause, and may simply kick the pain can down the road, OR make things worse if you experience any of the potential side effects.
I won’t go into detail on this since I’m not a surgeon, but as I understand it – surgery for plantar fasciitis is a plantar fascia separation. I take this to mean they are attempting to create space through surgical separation of the plantar fascia – and you can absolutely do this naturally, on your own, with a lacrosse ball (click here for the how to). However – tight plantar fascia is typically a symptom of the underlying issue and NOT the root cause. So even doing this naturally will likely need to be accompanied by other techniques as well.
What all of the above have in common are NOT addressing the root cause of pain and merely treating symptoms.
Have you been “stretching” as a way to relieve your plantar fasciitis? Here’s why it might be making things worse:
As most of you know by now, I’m not a fan of static stretching for most people (for any reason, but especially not if you’re in pain).
I see a lot of blogs and videos out there recommending you stretch your calves and feet to relieve plantar fasciitis. I NEVER recommend doing this.
The plantar fascia or heel is already irritated from tight tissue upstream pulling on it. So yes, the tissue upstream does need to be released. It’s the fascia however that needs to be ‘stretched’ and/or released, NOT your muscle fibers. Not only will stretching your calves not address the actual problem, it might make things worse.
Static stretching tends to pull on muscle fibers forcing them to lengthen in a linear manner. Much of the time your muscle fibers will resist being stretched like this, and in the case of plantar fasciitis it can often make your pain worse because you’re now pulling on the tissue that’s already irritated from being pulled on!
Plantar fasciitis is a fascial issue, and to get lasting relief it needs to be addressed by looking at and releasing key areas of fascia. So, looking at the calves is very much going in the right direction. But go after the fascia, not muscle fiber if you want lasting relief.
Break Up With Your PF™ - Say Goodbye to Plantar Fasciitis For Good!
This is part 2 of our 5 part series on understanding Plantar fasciitis. Click here for Part I and learn exactly what plantar fasciitis IS and what is causing it.
What’s in a name?
Have you ever noticed that we’re obsessed with naming things? We’ve given every pain in the body a title that includes something like itis, syndrome, disorder or disease on the end. We name viruses and flu strains, and there a lot of people who name their tumors when they get cancer.
In some ways, I get this: when we name something, it feels familiar and less scary. The unfamiliar or unknown feels scary.
However, I believe we’re doing ourselves a massive disservice with all this naming (at least when it comes to pain in the body).
Naming something does practically nothing to help us understand what’s happening or how to reverse it. What it does instead is allow us to take ownership of it. We say things like “I have sciatica.” “I have cancer.” “I have plantar fasciitis.”
“To have”: to hold, possess, accept; to get, receive or take.
Do you really want to hold, posses, accept, receive or take a named pain? Or do you want to find its root cause and eliminate it?
Instead of naming pain, let your body talk to you:
When you know how to interpret your body’s signals, not only will pain stop feeling scary but you’ll very likely quit wanting to name it. Instead, you’ll let your body talk to you. Every “negative” (painful) sensation is your body’s way of trying to communicate to and work with you, so you can both feel unstoppable and live a long healthy life. Your body isn’t trying to annoy or betray you, it’s asking for HELP.
When you look up ‘plantar fasciitis’ online it is almost always described as pain that shows up in the heel where the Achilles tendon meets the plantar fascia.
However, not everyone that experiences plantar fasciitis has pain there.
A LOT of you are experiencing pain in the ARCHES of your foot, maybe even under the ball or big toe.
Some of you may have BOTH at once – pain in the heel AND pain in arches.
Some of you have pain in BOTH feet; and some of you in only one.
Maybe you have pain in the arches on ONE foot and pain in the heel on the other…
Every one of these scenarios suggests a different root cause, possibly multiple and compounding causes!
This is one reason why I’m not fond of naming pain (be it plantar fasciitis, sciatica, ITBS etc), because when we do this, all the important factors – where the pain is, what it feels like, how it might jump around or move depending on activities etc – get lost and we focus on “having” and owning whatever name we’ve been assigned, instead of listening to our body and trying to interpret what it’s telling us.
Only by getting curious about what your body is telling you (feedback via sensation, immobility issues or pain through certain ranges of motion etc) will we start to unravel the puzzle and discover the root cause.
Pain doesn’t happen in a vacuum – it happens out there, in the ever-changing dynamics of life and how you are engaging your body in the world.
To reverse pain quickly and efficiently, we have to look at it out there as well, in the ever-changing dynamics of life and how you are engaging your body in the world. This is why, when I work with people one on one, I have them walk, lunge, jump, step up or down or go run outside in the parking lot – whatever movements get their body talking to them (and me).
Muscle attachments tell us a LOT:
When you start to tune in to your body and listen, you’ll notice where the pain is, what it feels like, whether it radiates or is sharp and stabbing, and whether or not it moves around throughout the day.
The most obvious and easy to understand “clue” your body gives is WHERE the pain is.
As you can see from this picture, clues appear when we note that the Achilles tendon attaches near the site of pain.
If you have classic plantar fasciitis in the heel only, chances are high your Achilles tendon is tight – and if your Achilles tendon is knotted up or restricted, chances are so is your gastrocnemius and/or soleus fascia.
If you have outside heel pain, in your case maybe it’s the peroneus muscles that run along the outside or lateral part of the calf compartment and THROUGH the lateral heel and ANKLE that are restricted.
Some of you have pain on the INSIDE of your heel, and when we look at that anatomy we see the medial soleus and gastroc muscles, the toe flexor muscles and tibialis posterior.
All of these muscles are the ones CLOSEST to or directly upstream of the foot, and MIGHT be contributing to your plantar fasciitis but it’s important to remember that it could also be something further upstream, or perhaps these muscles being restricted are a symptom of something else (a bigger overall issue such as a hip instability patter – which we’ll talk about in Part 5 of this series).
This is ALL valuable information because WHERE your pain is points to exactly WHERE you need to go to get relief.
Don’t worry, you don’t need to become an anatomy nerd to get yourself out of pain!
That’s where I come in.
I’ve learned most of the plantar fasciitis patterns by now, and I want to take what I’ve learned to help you get – and stay – out of pain.
If you’re in pain right now and want relief in as little as one week, then I want to help you walk away from PF for good!
Break Up With Your PF™ - Say Goodbye to Plantar Fasciitis For Good!
If you do – first, you have to understand what it is and what’s causing it.
This issue is one of the most debilitating and least understood “injuries” a human being can experience.
I put “injuries” in quotations because (and this is why this issue seems to confound western medical science), there’s often nothing structurally wrong (visible to imaging machines or other diagnostic methods) to point to as the cause of pain.
There are no broken bones, nearby joints probably looks ok, and usually there’s nothing ‘wrong’ with the soft tissue either (other than inflammation), from a western medical standpoint. There might be a heel spur, or minor tearing of the plantar fascia itself – but this is often looked at in a vacuum as the cause and site of pain when it’s actually a symptom of something else.
Without knowing the cause of something it’s almost impossible to know the solution.
Any attempts to eliminate pain without first knowing the cause is like throwing darts at an unknown target in the dark! The chances of hitting the correct target are next to nil.
If you’re ready to say goodbye to plantar fasciitis and hello to happy feet, click here. If you want to understand it more first, keep reading.
What IS plantar fasciitis?
Traditionally, plantar fasciitis is described as “heel pain,” but people are often diagnosed (or self diagnose) with plantar fasciitis whether they have pain in the heel UNDER the calcanues (heel bone) on the bottom of the foot, on the inside or outside of the heel NOT on the bottom of the foot (so, below the inside or outside ankle), whether the pain is in the arches and sometimes PF can be classified as pain under the ball of the foot.
While these details may not matter for a diagnosis (and I am NOT in the business of diagnosing anyone), they sure as heck matter to figure out the solution. We’ll be talking more about the various kinds of PF pain in Part 2 of this 5-part series.
In the simplest terms, plantar fasciitis is “inflammation of the plantar fascia.”
Hmmmm…this doesn’t tell us much, does it?
While it doesn’t tell us much…it’s a start. The problem with most ‘diagnostics’ is, they stop here. But not us. We’re going to take this to its end point – or, root cause. We’re going to ask why like an annoying little kid who will not settle for anything less than the truth, until we get to the bottom of this! (Pun intended?! :P)
So, your foot hurts. And there’s inflammation present…
Why is the plantar fascia inflamed?
Ahhhh…by asking this question, now we can get somewhere!
The plantar fascia is inflamed because something (or several somethings) are irritating it. In order to understand plantar fasciitis, we have to understand at least a little about fascia. After all, it’s even in the name of this debilitating issue!
If you want a more comprehensive crash course on fascia, click here.
What is fascia?
Fascia, or connective tissue, coats every nerve ending and then wraps the whole nerve. It wraps every fibril of muscle tissue, every fiber of muscle, every muscle bundle and then every muscle group is wrapped in large tough sheets of the stuff, which come together and turn into tendons and ligaments, also fascia – just a denser version – which connects to our bones. Every bone is coated in a layer of fascia, as are all of our organs.
We have MORE of this fascia stuff than anything else in the body! And this fascial system is meant to be elastic, flexible and able to move with us.
All fascia has within it something called ground substance and the extracellular matrix (ECM), and it is this ground substance that gives fascia its spring because it contains a gel-like substance that keeps the fascia hydrated and our cells nourished.
The ECM is responsible for distributing force and tension throughout the fascial system so we don’t damage ourselves from one hit (it’s our SHOCK ABSORBER!)
BUT – and we’re about to get into what the heck this has to do with plantar fasciitis here in a second – with overuse, under use, age and other factors like trauma and injuries, the fascial system starts to get dehydrated and then brittle. It LOSES ITS SPRING. It also sticks to itself in knots or adhesions, pulling muscle fibers with it and pulling on or irritating attchements.
It is this combo of dehydrated and knotted up restricted fascia that creates pain and inflammation in the plantar fascia.
This is the topic of a future episode. For now, we’re sticking to the anatomical or physiological causes of PF pain.
Most of the time, plantar fasciitis pain is stemming from tightness and restriction in your calves and hamstrings. Sometimes it can come from fascial restrictions higher up the posterior chain or in the upper body like your traps, but those cases are rare in my experience and often indiciate a deeper underlying issue.
The most common pattern that falls into this category is a hip or pelvic instability problem. Going after the glute in this case though wouldn’t be the correct solution, because the glute isn’t the problem either, it’s another symptom of dysfunction! (Part 5 of this series is all about this hip instability issue, and I’ll break it down for you so no need to understand it right now!)
Bottom line is…your plantar fascia starts to get irritated and angry. WHY?
Something (or several things) UPSTREAM are starting PULL on the Achilles tendon and plantar fascia.
At the same time, if your entire lower leg compartment has fascia that is dehydrated and brittle, you’ve lost the ability to absorb and distribute force and tension or in other words you’ve lost your SHOCK ABSORPTION! And…
With EVERY step you take walking around, and especially running, there’s nowhere to distribute the impact – so it’s felt –
And now we have a scenario where all those tiny bones, tendons, ligaments and joints in your foot are bearing the weight and impact of your body and activities, when that job is SUPPOSED to be distributed throughout your entire lower body.
This is one reason why it can start to feel like you’re walking around on a bruise. In many ways this may be quite accurate, because the calcaneus bone and all the small tendons, ligaments and joints within your foot start to feel the brunt of impact from every step and over time may very well start to bruise.
Your body may give you a pain signal here, or it might not happen until the fascia in your foot ALSO loses its spring and if the plantar fascia becomes dehydrated, brittle AND overstretched it is now in danger of tearing. This is one reason people get heel spurs – the body is trying to throw something down to make up for the loss in plantar fascia spring/length/durability.
OR, you may get the pain signal simply due to fascial restrictions in the calves and hamstrings pulling on the Achilles tendon and plantar fascia.
At some point the body, which is extremely intelligent and doesn’t do ANYTHING without reason, isolates that area for healing via INFLAMMATION.
Guess what inflammation does? It puffs up an area and mimics that squishy gel like make up of ground substance!
The body is likely trying to rehydrate that area with fresh plasma and prevent you from using it because that could cause further damage.
Little do you know, because no one ever told you this, but YOU CAN REHYDRATE YOUR FASCIA and give your foot exactly what it needs to stop getting your attention with a horrible and debilitating pain signal.
Most of the time plantar fasciitis is dead simple.
Like – there’s a tack in your forehead? Let’s pull it out! BAM! Done. That simple.
Notice I didn’t say easy, I said simple – the process of getting out of pain involves effort, curiosity and patience, but if it took you years to get here and it only takes a week or two to get out of pain, I’d say that’s pretty great success!
Sometimes however, it can be more complicated. In Part II we’ll be going over the different variations of plantar fasciitis, and why this matters for getting out of pain.
If you’re suffering with plantar fasciitis and want to get out of pain for good, check out our brand new course by clicking the picture link below.
Break Up With Your PF™ - Say Goodbye to Plantar Fasciitis For Good!